Reframing Addiction in Dentistry (E.273)

“Connection and community is really the anti-drug for everything.” ~Evan Rosenthal, M.S., L.P.C.C., L.A.D.C.

In this compelling episode of Everyday Practices, hosts Regan Robertson, Dr. Chad Johnson, and Dr. Maggie Augustyn welcome therapist Evan Rosenthal for a frank and illuminating discussion about addiction, treatment, and mental health. The conversation delves into the complex history of how society has viewed and treated addiction, from early criminalization to modern therapeutic approaches. 

Rosenthal shares valuable insights about the challenges individuals face when seeking help, including the role of shame, the importance of timing in treatment availability, and the various paths to recovery. The discussion expands beyond substance abuse to explore other forms of addiction affecting modern life, while also examining how professional licensing boards are evolving to support healthcare providers seeking treatment. 

This episode offers both practical resources and deep understanding for anyone touched by addiction, whether personally or professionally.

As you listen to this episode, we invite you to ask yourself the following questions:

• What unconscious biases or judgments might I hold about addiction based on society’s historical treatment of it?
• How can I be more supportive and create safer spaces for colleagues or loved ones who might be struggling with addiction?
• Am I aware of the resources and support systems available in my profession if I or a colleague need help?
• What role does shame play in my own life and how might it be preventing me or others from seeking help when needed?
• How can I contribute to changing the conversation around addiction from one of moral judgment to one of understanding and support?

EPISODE TRANSCRIPT 

[00:00:00] Announcer: The Productive Dentist Academy Podcast Network.

[00:00:02] Evan Rosenthal: The biggest thing about the moral model is that it lacks perception. People don’t understand for the most part that we are not intentionally doing most of the things that we’re doing. So, um, I think as humans, we also don’t intentionally do things as much as we could.

[00:00:17] Regan Robertson: Welcome to Everyday Practices Dental Podcast. I’m Regan Robertson and my co-host, Dr. Chad Johnson, Dr. Maggie Augustine and I are on a mission to share the stories of everyday dentists who generate extraordinary results using practical proven methods you can take into your own dental practice. If you are ready to reclaim your time so you can focus on great patient care without sacrificing yourself along the way buckle up and listen in. Doctor, did you know that PDA coaching doctors grew two hundred and nineteen thousand dollars on average in just the last ten months? If your revenue goals fell short this year and you suspect that patient communication and inefficient systems are holding you back, Productive Dentist Academy can help, but you have to take action. Register today for the PDA conference March 13th through the 15th in Frisco, Texas. Go to productivedentist.com to snap up your seat. It is the nation’s leading course for growing your practice and your team. Plus, while you’re there, you can set up a free 60 minute session to identify your own unique opportunities for growth and if you act fast, you could score a one on one with PDA’s co founder, Dr. Bruce Baird. That’s right. We’re only offering 10 and then his calendar is full. Don’t wait. Go to productivedentist.com right now and have a great 2025. We’ll see you in Texas.

[00:01:32] Dr. Maggie Augustyn:  Everyday Practices. It is my great honor to introduce to you Evan Rosenthal, who is a therapist and we are going to talk to Evan today from the perspective of a therapist and slightly talk about perspective of a patient and the reason why I’m so excited to bring you Evan is because as we were talking about the After Hours podcast, when we were still in the planning phases, Evan and I met. at the AGD meeting and we were eating breakfast together and he was wearing a bowtie and we just sparked up a conversation and really I was attracted to him because of the bowtie and then I found out that he was teaching a course. on addiction at the AGD and I was incredibly impressed and so even though we didn’t have anything solid on the books about addiction or about the after hours podcast, I asked him whether or not if in the future we were to have this podcast, he would be willing to come in and talk from the perspective of a therapist about addiction and so it is my very, very great honor to introduce to you Evan Rosenthal, someone that specializes in many, many different things when it comes to mental health, but he will be here with us talking about addiction. Evan, thank you and of course, my, my great friends and co-hosts, Regan Robertson and Dr. Chad Johnson also here to be a part of this monumental conversation. We are opening the door wide open as it should be among dentists, among dental professionals, and anybody else that’s willing to listen about addiction and how it affects us and how it affects the people that we love but we’ve. Before we get there, Evan, tell us a little bit about yourself, who you are, how you’ve gotten here, where you practice, and, uh, towards the end of the podcast, we’ll talk about how people can get ahold of you.

[00:03:19] Evan Rosenthal: Thank you for that nice and wonderful introduction. I did think about the bow tie today, but I didn’t, so, but I’m glad it had such an impact.

[00:03:26] Dr. Chad Johnson: That’s great.

[00:03:27] Evan Rosenthal: I am a mental health, chemical health therapist. I am currently licensed in Minnesota and Wisconsin. With some laws changing, I might be able to practice in a lot of other states very shortly, but not yet. So I primarily do individual therapy and then I do consulting on the side, specifically around mental health, chemical health, LGBTQI, queer stuff, trans, all around health equity, health access in all the facets, um, just because it’s such an important piece and I try to bring all of the pieces of the human into all of the discussions because we often talk about each other inside, doesn’t. Might do us the service. Sure.

[00:04:04] Dr. Maggie Augustyn: Yep. So many reasons why you’re my favorite person. You brought up the term human, but one of the first things that I, that I want to start with when we talk about addiction, uh, you and I have corresponded and spoken outside of this podcast in preparation, but one of the things that you brought up, and I really want to focus on this for the first few minutes of the podcast, and I want to talk about the historical criminalizing, pathologizing, and weaponizing of addiction. Um, speak to us on that. Talk to us about the moral disease. Talk to us about AA. Talk about being forced open to admit our addiction, how that affects us.

[00:04:37] Evan Rosenthal: Yeah. Um, such a light topic.

[00:04:41] Dr. Maggie Augustyn: You know, jump right in.

[00:04:43] Evan Rosenthal: History of substance use is incredibly interesting to me. I’m a history person, but we have this incredibly long history. We can go back into the stone ages and there is substances showing up for us. So this is not something that’s new, but as we start to get into the 1800s, then, well, if we go back to Plato, actually, Plato said, “Don’t use alcohol in excess because it’s not going to be good for you” and out of that came, started this moral model of, Oh no, if you choose it, choose to do this. It’s not okay. Then as we fast forward up into the 1800s, we start to look at this moral model that, and I want to be, give a caveat as I’m talking, there might be some triggers in here for some people. If you have substance use history, friends, family, whatever, just be kind to yourself but it’s really about people saying that you have a weakness or a poor character and Maggie, there was a note in one of our emails about, we spoke about strong, um, and I wanted to bring that in here because I have a double kind of nuance to that. When we’re talking about the moral model, that concept of strong is actually really pushing directly against some of that internalized moral model side of it because strong and weakness, poor character, those things are all, you know, pushing against each other and so after we talked, I really was like connecting. Um, we also spoke about strong as another context, which I can get to a little bit later but the biggest thing about the moral model is that it lacks perception. People don’t understand for the most part that we are not intentionally doing most of the things that we’re doing. Um, I think as humans, we also don’t intentionally do things as much as we could, but there’s so much all of us function on this. second to second basis and we have all these brain neural pathways that are like, yeah, this is how I believe the world functions. So this is where I’m going to go and those are, I’ve heard it best described as they start out when we’re really young and by the time we get, you know, even into our teens, these are rivers, you know, they’re trenches of rivers running and running and running. So, yeah, These neural pathways to try and change the direction of that, to change what you’re doing, you’re literally shoveling yourself out of this, this embankment and trying to redirect this rushing river, which is not an easy thing to do. So that moral model is. still there within us. It’s a lot of the socialized pieces, but we have moved forward from that. Before we get to the current stuff there, we have all of that, you mentioned pathologizing, criminalizing. Um, those two things kind of go together in some ways because we have the, the criminalizing part, war on drugs, which, you know, We don’t necessarily, I guess I say war on drugs with quotes, but we don’t necessarily have that language until we get to the seventies with Nixon, right, and then it’s public enemy number one and then Reagan just say no. Um, but it goes, this war on drugs goes all the way back when we start the late 1800s. There’s a couple of folks, Thomas Trotter and Benjamin Rush who start to pull in that medical model because they’re saying, “Wait a minute, This, we’ve said that these people aren’t well, we’ve said that this isn’t okay, but why don’t we look at some of the medical stuff that’s going on here? We can do more of them.” So in doing that, it started to shift, which was great, but it didn’t really shift fully until we get almost even up into the 90s and 2000, which I shiver as I say that because I was about to say the 2000s and that seemed weird, but, um, age myself, the pathology piece, one of the first diagnostic and statistical manuals for mental health, there was addiction placed in there. It was one of the first things put in there, but they labeled it personality disorder, which goes along with that.

[00:08:15] Dr. Maggie Augustyn: What year was it that it was placed in the DSM?

[00:08:17] Evan Rosenthal: 1952. It was with the. The first one.

[00:08:20] Dr. Maggie Augustyn: That seems like everything got put in there. Depression got put in there. Narcissism got put in there.

[00:08:25] Evan Rosenthal: Sexuality and gender got put in there. Yeah, everything and the language around it, it was also a lot more of, um, emotion-related and they were very specific about narrowing things into feminine and masculine categories also. Which some of that hasn’t seen

[00:08:40] Dr. Maggie Augustyn:  Do some people know about implants, Chad. I know a lot about mental health,

[00:08:44] Dr. Chad Johnson: Right? This make this, this podcast, the better of a listener that I am, the better this podcast will turn out. So I’m just taking it all in

[00:08:54] Dr. Maggie Augustyn: that I want to, that I want to point out, Evan, which is fascinating is as we talk about war on drugs and things like that, the things that they were fighting with a war on drugs nowadays, these drugs are becoming actually medicine like ketamine and psilocybin and MDNA, which I find interesting. But. But, but, but keep going with your history because we once again are so quiet, right? Because we find this fascinating.

[00:09:16] Regan Robertson: Well, but Maggie, just to chime in there, the mind that it has caused me as a D. A. R. E. student. So remember the D. A. R. E. program. Uh, to having the legalization of it and then trying to explain it to my children. That is a topic in and of itself. So I keep going. I am being quiet on purpose because I’m getting great education right now on how this all came to be.

[00:09:37] Evan Rosenthal: Yes. Dare. Um, I’m sure there’s a lot of folks who have some images and memories that are coming up around that. Um, it’s the criminalizing actually starts more so after they start to put stuff into medical diagnoses places and it actually, some of the most significant stuff starts in the seventies, right after we have the fair housing act in the sixties, when red line became no longer legal and red lining is there would literally be sections on maps and communities that were red lines around them where people of different color could live and buy houses and function. So it’s literally a few years after that, that all of a sudden we start to criminalize. all of the substances and really go after them more significantly. It’s also, so at that point, it was on the edge of the redlining, but it’s also on the edge of a lot of the anti war stuff that was going on. So all of the people that were being loud and visible and trying to make change or just trying to have fun, um, they were like, shh, quiet and that’s kind of how they did it. They just started putting some laws around. And we see as we go into the 70s, 80s, and all this forward, like the communities that they focused on with these were very police driven at times and so it’s not targeting, but it’s, and I don’t think it isn’t, um, it’s very interesting because as I said, talking about the whole human, all of this stuff, this history, it doesn’t happen in isolation. All these pieces, human understandings, identities are all intertwined and they all whisked around and change.

[00:11:18] Dr. Chad Johnson:Yes. Yes.

[00:11:319] Evan Rosenthal: Um, Maggie, as you were saying, like psilocybin and ketamine and some of those are becoming legal now. If we go back into the 1700s, they were all legal and religion was using them all the time for different things, you know? So we also have these cycles that we go through of legalized. Not legal, legalize, um, which is very much so our history too. I don’t want to go too far into that, but if we mirror ourselves back a hundred years ago, there’s some similarities here.

[00:11:40] Dr. Maggie Augustyn: And so then in nineties we had dare.

[00:11:42] Evan Rosenthal: Yes, we had dare and we started to, that’s when like the three strikes laws started in some different states and three strikes. A lot of those were just possession, possession, meaning they had a small amount of weed, um, maybe cocaine that they had on them and for some reason they were stopped and they were searched and they found this. And so that was a criminal offense and so literally someone could be caught three times for having some weed and they were in prison for life.

[00:12:08] Dr. Maggie Augustyn: Yeah,

[00:12:10] Evan Rosenthal: And then we’ve since gone back on that.

[00:12:10] Dr. Maggie Augustyn: Yeah, and then we got it to the 2000s, which, how were those different?

[00:12:14] Evan Rosenthal: The 2000s kind of started to be a little more deliberate. That’s when we started, right around the 2000s, we started to change, uh, from a mental health perspective, diagnostically. For many, many years, part of diagnosing substance use was one of the requirements was legal history and it’s while some folks do have that connection, that’s not necessarily substance use related. There can be system things and other pieces that can play into that. So when that disappeared, that was huge of taking some of the pathology negative criminalization. So now it’s more open.

[00:12:50] Dr. Maggie Augustyn: So we’ve got this beautiful background and the history and pathologizing weaponizing of addiction. One thing that I also want to want to touch on that you mentioned is some of the AA recovery models and forcing people to be open about the addiction and what that does. Can you, can you speak for a short time on that because I found that to be fascinating? Um, and also the, the forcing of religious models as we. Open up about our addiction. Yeah,

[00:13:19] Evan Rosenthal: yeah. Um, all the aa, um, abstinence, um, a lot of that stuff well starts to come out of Minnesota in the 19, later, 19 hundreds but the biggest piece when we talk about religion, sneaking in, in aa, AA was originally created with Christian Foundation. You had to find that higher, higher power, and that was the only way, admit you’re powerless and find this higher power, and you had to follow them. Uh, it has since backed off on that a little bit. There’s other religions and there’s actually facts that you can connect to that don’t happen. Um, 12 step models have evolved into all kinds of stuff, even beyond substance use and so for many people, they’re incredibly helpful, but that religion piece is still kind of there for many folks and when people stand up at a meeting and they say, hello, my name is Evan and I’m an alcoholic or I’m an addict, however, You define yourself. Like, that’s a lot of pressure. These people that you’re at your first meeting or one of your first meetings and, you know, the idea is these people are here to wrap you up and everyone will notice hopefully that you’re one of the new ones and create this little nest for you, which is amazing, right? And a lot of folks don’t return after the first one. If that was too much for them to say out loud because when we say things out loud, they take on a whole new meaning. Sometimes they have a lot more power.

[00:14:38] Dr. Maggie Augustyn: So AA has been tremendously successful and it’s helped a lot of people, but you’re saying that, that it definitely is something that is quite difficult for many people to, to swallow. The gentleman from Iowa has raised a question, has a question,

[00:14:52] Dr. Chad Johnson: Question. So I’m naive to AA. Uh, is this something that they’re volunteering to go to, or is this something that is semi mandated because it’s either go to AA or go to jail? I’ve heard some of this talk, but help me understand cause I wouldn’t know. Yeah.

[00:15:08] Evan Rosenthal: Yeah. Great question. Um, and I want to reiterate that. AA has evolved and is so amazing for so many people. Oh, sure. For so many people, it’s not.

[00:14:52] Dr. Chad Johnson: Yeah, I heard that. You, you, you did mention.

[00:15:08] Evan Rosenthal: There’s AA, there’s NA, all of these pieces and they’re supposed to be voluntary because you want to move in or you want to be doing this because it’s an internal motivation. Um, forced sobriety isn’t necessarily long term sustainable. Unless you have some internal motivation. So, they might make it as part of a treatment plan, but isn’t court ordered per se. People have to choose to go there and choose to continue going there, choose to engage and when you go to a meeting, there can be any number of people a lot of times the images of people sitting in a circle with some coffee or snacks to the back and you just talk about this past week or since my last meeting, this was what triggered me, this is what I need, um, I’m struggling or I used and then I stopped and then connecting in that community, connection and community is really the anti drug for everything. So that concept of, we have this space right here, be open and put all of your stuff out here is, is amazing.

[00:16:17] Dr. Chad Johnson: So just to follow up to just to make sure, but people aren’t, let’s say they do a plea bargain. To me, that would be. Semi coerced potentially from an attorney saying, “Listen, I can get you out of jail, but we’re going to agree to you going to this.” It wasn’t the, the participants idea, you know, like I really should go check that place out. You know, they have fun snacks, so they’re not saying that, but like, so then it’s semi coerced. Right. Am I reading that right? That that could be a possibility for some that they’re like, suppose I’ll go on Friday and, you know, check that out.

[00:16:50] Evan Rosenthal: A lot of times. In my experience, I’ve more so seen lawyers say, go do this thing because it will help us. It will show that you want to change. It will show that yes, this can change your sentencing. It’s kind of coming in a little bit before to start the process to show that someone’s not always. Uh, a lot of times it’s part of, you know, discharge plans from criminal systems.

[00:17:11] Dr. Chad Johnson: And that’s okay. Thanks for helping me clarify because again, I’m quite naive to that.

[00:17:17] Regan Robertson: I don’t know if there’s any data that supports it or that’s out there, but this is wildly fascinating to me. One, because it helps me understand the criminalizing. Helps you focus on the addictions, why the addictions get so much attention, because I have brought up multiple times throughout our podcasts about addiction being in many different forms, and that’s a whole separate discussion in itself. So it helps me understand why we put focus on it, but also what is the adoption and success rate about showing up and being authentically yourself. If you are mandated to go to a program and you still have to compromise who you are in order to be. kind of fit in that box versus I just think so much is driven on your belief versus those that are comfortable with that format and that belief system that you are now subscribing and saying that I, you know, I believe in the, what the difference is. I guess it’s a, an example of the complexity of our society. So because it works for one, does it work for all? And if you have to do this, what is your success rate? Does that, I mean, I don’t know if there’s alternatives to, to AA. And I agree, all of us agree. AA has been phenomenal for so many people, but it’s just in introduces a nuance, I guess, that I never thought of before.

[00:18:23] Evan Rosenthal: Yeah. The other piece of it. So treatment looks different for everyone. Sometimes, um, we need to focus more within mental health. Sometimes other areas also like housing is an incredibly important piece. You’re not going to be able to move forward without housing or stuff like that but when it comes to treatment within the state of Minnesota and most states have an assessment process to determine what’s called what level of care they need. So anything from you might benefit from a few social groups or treatment groups to we need you to be inpatient and you’ve done this so much that we’re actually going to order you to inpatient treatment until we can get you sober and starting to do some other things. So, AA can fit in anywhere in that process and I think that’s one of the big parts when you go into treatment, it’s kind of the same concept of you are supposed to, you know, put those things out there, but this treatment setting is a little bit different in that you’re living with these people if you’re doing inpatient all day, every day and so you build a different connection than just walking into a room, folks, that you might see for a couple of hours a day but a lot of treatment facilities also do AA groups, NA groups, all of those things to help folks get used to going into that setting so that it’s not as difficult or not as, you know, scary when they go in the first time.

[00:19:39] Dr. Maggie Augustyn: And Evan, I’ve got two next questions. One of them is give us examples of the types of addiction that people get treatment for follow up question, which is going to be our next really big question from the perspective of both the therapist and a patient and this is really the reason for this particular episode is show us the behind the scenes of what it looks like when someone that is struggling with addiction is finally reached a time when they’re ready to admit that addiction and go in for treatment. When you and I have. some time talking about it and I really want to give our listeners a bird’s eye view of how incredibly difficult that those moments are.

[00:20:17] Evan Rosenthal: Yeah. Um, the different levels and different types of things that can go in that you can seek treatment for a lot of it is very dependent upon insurance. If you are private pay, you’re going to get a lot more diversity and the types of treatment you can get, where you can go, how long you can stay, all of those things, but for the overwhelming majority of us, we have to work with our insurance and so that will often then also dictate whether we get inpatient, outpatient, how many days, how many sessions. all of those pieces and there’s everything from, you know, you’re locked into a facility to you can leave a facility, but you’re there and they have partial hospitalization. So you’re living somewhere and going to treatment intensive outpatient. So it’s outpatient and you can be living anywhere, but you might go for a couple of hours every day and so they’re still intense and then it’s this continuous potential step down process where someone enters is really based on what’s for them, what resources they have around them and what they. are willing to do in many ways. So one of the things that we talked about, though, was the challenges from the moment if I’m sitting here right now and I say, “I think I have a problem and I need to go to treatment or I need some, right?” The process for me, one, admitting that to myself is incredibly difficult. I think admitting something and being truly honest with ourselves is one of the hardest things as humans.

[00:21:38] Dr. Chad Johnson:Absolutely.

[00:21:39] Evan Rosenthal: So saying that, but then what do I do? Do a lot of us are like, I need help. So I go talk to someone and telling someone is really difficult as well because you put a lot on the line because that moral model that we’re talking about is ingrained and how are they going to respond? So you might have this person who guides you, you might not, and you get to the point where you can ask someone to say, “I want to go into treatment,” and if you’re dealing with insurance, the insurance is going to say where you can go, what facilities, and then it’s kind of a coin toss because there may or may not be an opening for a day or a week or so, and that lapse in being able sometimes to get into treatment, this happens with mental health outpatient as well. Like folks, if they want to get in with me, I’m about two weeks out right now, which is not bad, but it’s a length between when they decide start and when they can and in that period of time, that motivation can change some of those shame spirals about what’s happening, what they have to admit, what they’re realizing is happening, some of that stuff starts to come up and not everyone makes it to treatment at that.

[00:22:42] Dr. Maggie Augustyn: Yeah, I mean, if you’re if you’re facing an addiction as a dentist, and you are coming to a mental health provider and you’re saying, “I’m ready to admit this to my community, to my church, to my spouse, to my children, to my patients. I will shut down my office and I will go into treatment,” and then you’re being told, “That’s cool dude, but you got to wait two weeks, right? Either your pre authorization for insurance, needs to go through, or we can’t find you a bed for two weeks.” For those two weeks, you’re like, “Mm, I think I changed my mind. I’m gonna go back on the street and score some, some more, you know, Vicodin, or whatever it is.” That is insane.

[00:23:22] Evan Rosenthal: Yeah, there’s also, I know this a little more from a mental health perspective, perspective that they’ll keep folks in the, in an emergency department for an extended period of time waiting for beds. And that’s not helpful either, because you’re just in this space having no treatment, no interaction with anyone. They took all of your things from you because they do that. If it’s anything mental health or substance use related, just for safety, the system is not working with folks. It’s at max capacity and it’s not really intended to work in the ways that we have evolved. Hmm.

[00:23:51] Dr. Maggie Augustyn: How is shame involved? How have you seen patients present when they’ve just told you and not their loved ones and not their community and not their, you know, the people that they work with or their church or what does that look like?

[00:24:06] Evan Rosenthal: Yeah, I think shame is one of those pieces when we talk not just about substance use, but of any kind of secret that the world tells us maybe we shouldn’t do or we shouldn’t have that we keep to ourselves, it can create that shame piece in us and most of those are rooted in our young lives, right? When we’re really little, we watch the world to figure out how to navigate it and we see, “Oh no, I did this thing and I got yelled at, Oh my gosh, I am bad,” and this creates this like shame spot that grows and carries this individual message that in cognitive behavioral therapy, they call a core belief, and it starts to impact your entire life. There’s a point where some shame, especially when we’re younger, can be helpful. It’ll deter us from doing things. That’s great. As we get older, shame tends not to be as productive for us and so then we have this tool that’s been really helpful in getting us somewhere, but it’s not currently helpful. So we have to kind of start to change those things. But this concept of I am bad is this core that we’re sitting with and if you think of I’m going to share something out loud and in the core of me, “I’m saying I am bad along with this.” Like, that’s awful, right? Nobody wants to do that.

[00:25:20] Dr. Chad Johnson: And so it’s interesting that you preemptively said that shame. Can have an advantageous component to it because I was actually going to ask that I was, I was going to say, I know it’s a weird question to ask, but like, is there a possibility that there is a good side of shame? And you also notice, uh, how the older that people get, let’s say there’s a 60-year old, anyone, and they just go, you know, “I used to care and now I don’t care. I just say what I think, or I. It’s almost like they’re bypassing.” They’re saying at one point, this used to shame me. Now I don’t care. I’m just going to say it. Can you speak on that? Like that’s basically anti shame right there, right? They’re basically saying I’ve got license to say what I want, because in spite of the fact that I used to care, this needs to be said, or this needs to be done.

[00:26:07] Evan Rosenthal: Those same pieces turn into the core beliefs about how we see the world and so we grow to believe that. And so whether they’re shame or not, a lot of folks, then as we get older, we’re just more comfortable with. I don’t have the consequences of I’m going to have to stay in recess if I tell this person that .

[00:26:25] Dr. Chad Johnson: I’m 60, what are you gonna do to me? Yeah, right, right.

[00:26:27] Evan Rosenthal: Yeah, absolutely. So that can be part of it. There’s lots of different layers to that too as we grow depending upon where we’re living the circumstances socio economic stuff education whether We have certain caregivers in our lives or not siblings. Trauma is something that I haven’t said very much about. But trauma is such a big piece of action. And so any of those things can create this combination of things that have people either overtly acknowledging or doing things or sometimes even just squeezing tightly inside.

[00:26:59] Dr. Maggie Augustyn: And how do you help people overcome that shame as they you either get ready to disclose, because one of the things that I want to address is when you’re facing addiction and addiction treatment, you don’t have to tell the whole world and especially being a dentist, you know, that becomes really tricky with our licenses or, you know, anybody holding a license that becomes really tricky and so when you’re facing shame, most people probably tell their families and their communities, um, but they, they do hold some of that secret. Talk to us about the disclosure of that secrecy and how that plays out or continues to play out throughout the cycle of the addiction and many years after the healing of the addiction.

[00:27:45] Evan Rosenthal: I think an important piece of what you were saying is if you have the community around you to tell a family member, tell a friend, tell your church community or religious community. Like those things are the support and connection that are going to make that process easier. I’m not saying it’s easy, but it’ll be a bit easier than say a young person who was kicked out of their home, who’s trying to figure out identity stuff and all of those pieces. Them saying that and trying to follow through with that is, it’s harder because they have in some ways, nothing to lose, but they also don’t necessarily have anything to gain, which can be really difficult. So there’s that piece that plays into it, but a lot of it, when it comes to shame, this is a long process. This isn’t something that someone walks into my office, I might look at someone and be like, “Hmm, I think that there might be some of this there,” but it’s not coming out in the first session. We’re going to talk about things, and depending upon the human, the types of trauma they have, it can be years before some things come out, it can be years before, other, you know, mental health, chemical health, or other things can come out when it comes to something that is just so secretly held within us. One of the things that we expect folks to talk about, which isn’t easy, there’s times when we give it enough credit and there are times when we don’t but talking about dying by suicide, when we have these thoughts, this is this huge piece that is similarly tied up in this shame, but we’re also given this great dialogue of, you know, there’s people who might help you right with substance use. We don’t always have that message, so it can become a little bit harder to find and admit those things. Is that how?

[00:29:19] Regan Robertson: Yes. All of it is helpful. I want you on for like five episodes, you know, um, thinking about my own journey with my own therapy. So my life got to just a point where I just couldn’t navigate things like I used to and I, I searched online and it was similar. It was like, what, what does my insurance take? What’s the right, you know, I went to Google and just kind of looked it up. I got very, very fortunate to find a great therapist that connected with me well. And other than podcasts like this, what are some ways that people can find resources? In addition to going the insurance route, which gives you a limited option.

[00:29:55] Evan Rosenthal: Yeah, the insurance route, yes. Like, where do we find, do they have openings? And this is January when a lot of deductibles restart as well. So there’s that difficulty in access sometimes this time of year as well but there are, as you talk about professionals, licenses, those sorts of things, most states and a lot of professional organizations have some services built within them for mental health and substance use. There’s often a group that you can connect to and they will work with you to help monitor your use or to monitor your treatment so that you don’t have to lose your license, but that you are being open and honest about it to your license, which can be really scary as well. There’s also, um, when we talk about flight attendants, there’s large groups to support them as well so that they can seek treatment for a lot of different things.

[00:30:42] Dr. Chad Johnson: Yeah. Great. What, what is that? What does that mean? Like, um, because people are mad at them and stuff or like, why flight attendants? What does that mean? What do you mean?

[00:30:52] Evan Rosenthal: Um, they’re just like all the rest of us. They have substance use, mental health concerns and when you’re in any work environment where you’re customer facing, I think there’s the potential for that to really get poked down a lot and so how you cope about that, or as you were saying, Megan, about, I don’t have these tools anymore to do this.

[00:31:08] Dr. Chad Johnson: So they’re like dentistry kind of where. Like you’re supposed to save face in front of the client slash customer slash patient, and they can berate you and you just are supposed to smile and move on.

[00:31:20] Dr. Maggie Augustyn: They probably get it worse than we do.

[00:31:21] Dr. Chad Johnson: I bet they do. Yeah. Wow.

[00:31:24] Regan Robertson: I had no idea. I had no idea that you could go to like your board too, because to me, that would be a huge stigma and a huge reason why I would continue to hide. Like, you know, this is not just going to affect me. It could affect my practice. It could affect. Everything in my life, which that sends you down that path. It’s just dangerously dreading into hopelessness. So I had, I had no idea, Maggie and Chad, did you guys know that?

[00:31:45] Dr. Chad Johnson: I did because it seems like our board is trying to be with the times progressive enough to say, “Hey, we need to embrace and foster a family culture of, if you want to get better and you’re willing to be proactive about it, that we can in kind respect that over your cot, you know,”

[00:32:05] Regan Robertson: You don’t have to lose your license, and it’s.

[00:32:07] Dr. Chad Johnson: Yeah. So, uh, I don’t know, I’ve read it in our code. I just thought I’d point out that Iowa is pretty awesome. It’s a, it’s like three degrees better than Minnesota. I just had to do a dig, man. I’m sorry. That’s just because you’re from the south. That has nothing to do with anything. No. My last couple of sentences, I’m striking from the record. That was malarkey. I was just, uh, just giving you a hard time. Absolutely.

[00:32:31] Evan Rosenthal: Yeah and, but a lot of states will have something like this. You don’t necessarily have to go directly. to your licensing board but I just googled a little bit through the ADA and they do have wellness something that you can go and they have peers who will help you through certain processes or help you connect to things. I don’t have any experience with that but there’s a lot of professional organizations that will offer that as well.

[00:32:54] Dr. Maggie Augustyn: And there’s a lot of colleagues, there’s just a lot of really good people in our community that have been through some difficult times in their life and they, you know, like Alan, like Alan Mead that we interviewed that, that will lend a helping hand and a listening ear and can help direct you and help guide you and answer questions and things like that about these processes.

[00:33:18] Evan Rosenthal: Yeah, even as a therapist, like I work within this system and many years ago when I had to find my own individual therapist, like I found someone, found someone, no, because they’re not always the right fit too. That’s one of the challenges we’re saying, “Go meet with this person,” but we’re all humans and we don’t all connect in the same. There’s also, depending upon availability and. what you’re looking for. You’re stuck with someone that maybe doesn’t fully understand you or you don’t fully relate to, which makes admitting those things are growing.

[00:33:47] Dr. Maggie Augustyn: And when we talk about addiction, like, you know, clearly we’re talking about alcohol and we’re talking about some hard drugs, right? We’re talking about, you know, um, maybe Vicodin or, or some of this, but what about Shopping addiction or phone addiction or sex addiction. I mean, these are like some, I don’t know if the right term and please apologize. I apologize if this is not like these are maybe friend, like these are just unknown and uncommon addiction but nonetheless, these are things that can really ruin people’s lives like gambling addiction. That’s a well known addiction but what are some uncommon addictions that people can really get lost in?

[00:34:22] Evan Rosenthal: Gambling, sex, any type of repetitive behavior. When I went through my graduate program, one of the tracks I did substance use, but there were only like two or three more courses and I also got a relationship with food emphasis because there’s some crossover. One of the challenges is there’s nuance between them and so I don’t say that I’m like, I can work with relationships with food. I can monitor it, but I’m not. has tuned into that stuff. So when it talks, when we talk about sex or other things, shopping, social media, our phones, like we’re all conditioned to do all these things and a lot of treatment centers, if you’re going inpatient are starting to have a bigger, wider lens to be able to approach these. It depends upon where you’re going and it depends upon insurance and all of that stuff too but as a primary diagnosis, something that isn’t a substance, uh, alcohol or a relationship with food, it’s really hard to get treatment because

[00:35:19] Dr. Chad Johnson: Those things are like the, the ultimate goal is the dopamine hit slash whatever. It’s not necessarily the drug that’s exogenous. That’s going to get, but like, if the shopping gives you or the scrolling gives you that dopamine rush, then that’s what I think. I wouldn’t know, but it sounds like that’s what our brain is after anyway.

[00:35:38] Evan Rosenthal: Yeah. I read recently this interesting article and I apologize. I don’t remember who it was written by, but it was like 2005 and they were talking about, evolutionary, like all of our positive emotions that created that dopamine release, those were advantageous so that we could survive so that we would connect with people, find the food that we needed, those sorts of things and the ones that didn’t create it, the uncomfortable emotions, those were warnings to not do those things, right? If we do those things, then we’re not going to be able to do all this. So as we have evolved as humans, as you’re talking about this, it really is that. Dopamine, our brain is saying, “This is good. This is something that means I’m going in the right direction,” when in current human terms, we’ve evolved past that , so it’s not as advantageous, even though it feels really good. And that can be really tricky for folks too, because this feels good. So it helps me with things but in the long run.

[00:36:36] Regan Robertson: So do you help people then address the underlying reasons, the underlying behaviors that are driving that addiction, no matter what it is? And I, I’m so pleased, Maggie, that you brought up the other addictions. I talk to my children about it a lot, bone in particular. So I, I tell them this is my, what I think of as my generation’s cigarettes. So I am addicted. actively addictive. I say, I say the classic things. Oh, I can stop all the time. I’m going to deactivate Facebook and my daughter is real quick. She’s like, “Yeah, you did that once before and now you’re back on it again. So what, what’s going to be different this time,” and so even whether it’s criminalized or not, it can be unhealthy and ruin the quality of your life. So therapy in particular is one resource to help you. I’m assuming get under that surface.

[00:37:20] Evan Rosenthal: Yeah, trauma is often indicated and, or is often under there or intertwined in some capacity because when our body has a trauma response, it’s that instinctual cortisol, adrenaline, changing your heart rate, breathing, like ready to run and fight a tiger if you need to but most of the time in our day to day life, we don’t do that, but our body will still respond like that. So that can feel so wildly out of control. You don’t want to feel that and so if there’s something that can help with that, which substances do, there’s a high correlation or connection between those two. But then if you start using substances, there’s a greater likelihood of experiencing other types of trauma and so it can become this really tight wound all that we’re looking at. So sometimes as I’m working with folks, sometimes it’s about naming and saying you had some stuff that happened when you were young. You’ve had some stuff happen since you’ve been using and. These are all really tied together, so we’ll start with some of this stuff that feels more immediate and it’s going to tie into these things. I’ve also had situations where folks come in and they’ll be very open about how much they’re using of a substance, weed or alcohol, and they’ll say, it’s not a problem, I just want to lose weight or I just want to have more energy and so I’m like, “Okay, let’s work on that.” Um, in my head, I’m like, this is going to eventually steer in that direction and we’ll have to talk about it. But if you’re comfortable staying with me to work on this, we can do that for a little while and as we build a relationship, I can push and lean us more.

[00:38:52] Regan Robertson: Oh, I love that you, that you, this is where to me, therapy is a, is a piece of coaching elements too. It’s understanding that human and what they’re capable of handling in the moment and whether that is tackling big chunks at a time or slowly. putting in systems to help the person even acknowledge what they might not be aware of, you know, and I speak from personal experience, it’s been a year’s long process and when I have those aha moments, it couldn’t have come to my attention without all those little pieces set up. There’s so much work, I think, and education that goes into being a great therapist and understanding and meeting that person where they’re at. I have an oddball question for you as we wrap up here, you mentioned, well, you mentioned connection and community is really the way out of this and I know our podcast, you know, our goal is to share stories so that we can lower that stigma and help people feel connected. Is there resources for you and therapists? How do you all like, how do y’all get together and learn from each other from each other because, you know, we have listeners all over the nation and, um, and they won’t necessarily be able to fly to see you. So I, I don’t know how, how you keep connected with your own community.

[00:40:01] Evan Rosenthal: Yeah. Part of it is I am part of an amazing group practice in Minneapolis where we are specifically queer trans and so I can walk into that space and completely be myself and the people around me are going to say, “Oh, this thing’s happening in the world and we’re all kind of connected, supporting each other.” Which is incredibly helpful, but not everyone has that. So there’s been a lot more online stuff happening. I think it’s really important. You were saying like the buildup to get to some realizations and we’re like, “Oh, like that happens for us as therapists too.” I think sometimes listening to my therapist is one of the hardest things I do because, you know, I know it’s what I should do. And. You know, I have the same thoughts and feelings of as everyone else. It’s much easier to be in the therapy chair than client chair. Much like probably in your roles too.

[00:40:48] Dr. Chad Johnson: Do you know, I actually, Evan, I actually admit that to patients in a joke. It’s nice to joke as a dentist to kind of diffuse, you know, the Yes. You know, I’m just like, listen, I mean, this, this is a lot harder for you than it is for me. I mean, sitting in my chair is no problem.

[00:41:04] Evan Rosenthal: Yeah and sometimes just acknowledging, um, with clients or with colleagues, you know, when we’re acknowledging that crossover of we’re all humans and so we all function some similar ways. We also within the therapy community, we have this concept of grandparent therapist, great grandparent therapist, where like, I have a therapist and my therapist has a therapist and they have a therapist and we talk about one grand therapist somewhere, but I’m not sure. um, . So we, it’s a lot of us connecting in a variety of different, some, a lot of us have individual therapists, a lot of us have virtual or in-person networks. It’s so incredibly, I really,

[00:41:41] Regan Robertson: I’m so happy to hear that because of all the therapists, Carrie. So I’ve always wondered that thanks for kind of opening your world ’cause that’s a lot to carry every day and I think it’s a great link to physical healthcare like dentistry because Yeah. You know, the many doctors that I am honored to speak with a, after one day can be so draining because the really great ones are great listeners, first and foremost and that means that they can’t help but have empathy and understand people’s stories and so to understand that therapists also deserve, you know, the support and have support I think underscores what we’re here for today. Thank you, Evan, so much for being on our podcast and, and sharing, um, all of this You know, the history of how we view addiction and, and what we’re doing about it today to tackle it and some of the barriers that still exist today, um, and what we’re currently working through.

[00:42:26] Dr. Maggie Augustyn: Evan, how can people get in touch with you?

[00:42:27] Evan Rosenthal: I work with Transcend Psychotherapy in Minneapolis. I have my email through that. Otherwise, my direct email is my name, evanrosenthalconsulting@gmail.com. I just kept adding words because

[00:42:43] Dr. Maggie Augustyn: Any one of us and we’ll connect. Yes.

[00:42:46] Evan Rosenthal: Yes. If you Google my name, some stuff will come up. Thank you for inviting me and thank you all for the work that you’re doing, but taking the time. Crossovers in professionals and understanding people as whole humans is hugely important.

[00:43:00] Dr. Maggie Augustyn: We are so grateful for the collaboration and this conversation. Thank you so much.

[00:43:06] Regan Robertson: Thank you for listening to another episode of Everyday Practices Podcast. It would mean the world if you can help spread the word by sharing this episode with a fellow dentist and leave us a review on iTunes or Spotify. Do you have an extraordinary story you’d like to share or feedback on how we can make this podcast happen? even more awesome. Drop us an email at podcast@productivedentist.com and don’t forget to check out our other podcasts from Productive Dentist Academy at productivedentist.com/podcasts. See you next week.